Pituitary tuberculoma masquerading as a pituitary adenoma: Interesting case report and review of literature

Abstract

We present a rare case of a pituitary tuberculoma masquerading as pituitary adenoma with pituitary apoplexy-like presentation in a 31-year-old female, who had symptoms suggestive of acute secondary adrenal insufficiency with secondary amenorrhea. After initial evaluation which was suggestive of pituitary adenoma, she underwent endoscopic transnasal pituitary tumor excision. Histopathology revealed features of pituitary tuberculoma. She was subsequently started on four drug anti-tubercular therapy and is on follow-up. Although uncommon, tuberculomas, especially in the pituitary gland, are known for behaving like pituitary adenomas, by impairment of pituitary hormonal function and by exerting pressure effects on surrounding vital intracranial structures. Diagnostic challenges, treatment modality, and literature review are presented in this case report. Pituitary tuberculoma even though a rare entity should be borne in mind as a differential diagnosis in a patient manifesting with pituitary apoplexy-like syndrome.

Pituitary tuberculoma with panhypopituitarism masquerading as a pituitary adenoma

“…The preferred approach is transsphenoidal, which prevents the chances of CSF contamination and simultaneously provides tissue material for histopathological examination along with tumor decompression. 13 Apart from adenoma, the other differential diagnoses to be considered for a sellar mass are Rathke's cleft cyst, haematomas and infective etiologies, including toxoplasmosis and neurocysticercosis. 14 A clinicoradiological and histopathological correlation is of utmost importance in excluding the differentials.…”

“…Surgical intervention is needed to resolve the diagnostic dilemma and relieve pressure. The preferred approach is transsphenoidal, which prevents the chances of CSF contamination and simultaneously provides tissue material for histopathological examination along with tumor decompression 13 …”